n,.

Concept of Health, Wellness, and

Illness Betty Neumann
- Health is a condition in which the
How do I define Health? parts and subparts of the whole
“a state of complete physical, mental, and person are in harmony
social well-being, and not merely the - Systems model
absence of disease or infirmity.” Sister Callista Roy
- Health is a process of state of
being and a process of becoming
Mental/
Social an integrated whole
emotional
well- healt - Roy’s adaptation theory
Jean Watson
- Health is more than an absence of
disease
physical - It is a harmony between the mind,
*all sides should be equal body, and soul
- “What the mind can conceive, the
Definition of Health from Nursing body can achieve”
theories - The philosophy and science of
Florence Nightingale human caring
- Health is being well and using
one’s power to the fullest extent Alternative Definitions of Health
- Maintained through prevention of
disease via environment health Walter Cannon - it is the ability to
factors maintain homeostasis or dynamic
- Environmental theory equilibrium
Imogene King
- Health is a dynamic life experience Claude Bernard - Health is the ability to
- A continuous adjustment to maintain the internal milieu while illness is
stressors in the internal and the failure to do so
external environment and the use
of one’s resources to achieve At present…
maximum potential *multifactorial
- Theory of goal attainment *holistic
Madeleine Leininger *optimal/optimum functioning
- Health refers to beliefs, values,
and action patterns that are
culturally known and used to
preserve and maintain personal or Wellness
group well-being and to perform
daily roles activity WELLNESS
- Theory of transcultural care - Is a choice/ way of life
nursing (culture care nursing)
 - Quality or condition of being well Intellectual - ability to make sound
even in the presence of illness decisions and to think critically
- Not simply the absence of disease -includes openness to new ideas,
or clinical manifestations motivation to master new skills and a
- It involves engaging in attitudes sense of humor, creativity and curiosity
and behavior that enhance the Social - ability to interact successfully in
quality of life and maximize one’s our global community to live up to the
potential expectations and demands of our
- An ongoing process directed personal roles
toward higher potential, not a static -learning good communication skills,
goal developing intimacy with others, and
creating a support network of friends and
High Level Wellness - an integrated family members
method of functioning which is oriented -includes showing respect for others and
toward maximizing the potential of which yourself
the individual is capable within the
environment where he is functioning Environmental - awareness of the
(Dunn, 1979) unstable state of the earth and the effects
of your daily habits on the physical
Wellness has seven dimensions. Each environment
dimension contributes to our own sense -maintaining a way of life that maximizes
of wellness or quality of life and each harmony with the earth
overlaps or affects each other. At times
one may need one more prominent than Occupational/vocational - involves
the others, but the neglect of any one preparing and making use of your gifts,
dimension for any length of time has skills, talents, in order to gain purpose,
adverse effects on overall health. happiness, and enrichment in your life
-related to your attitude about your work
Physical wellness - encompasses a
variety of healthy behaviors including Spiritual - possessing a set of guiding
adequate exercise, proper nutrition, and beliefs, principles, or values that help give
abstaining from harmful habits direction to one’s life
-Learning about identifying symptoms of a -encompasses a high level of faith, hope,
disease, protecting yourself from injuries and commitment to your individual beliefs
and harm, getting a regular checkup that provide a sense of meaning and
purpose
Emotional - understanding how we feel,
accepting our feelings, and learning how Models of Health and Wellness
to express and cope with our emotions 1. Halbert Dunn’s high level wellness
-encompasses optimism, self-esteem, - Described a health axis and
self-acceptance, and the ability to share environmental axis interact
feelings Quadrants:
 1. High-level wellness in a favorable -used in predicting illness through
environment identification
2. Emergent high-level wellness in an 3 dynamic interactive elements
unfavorable environment 1. Agent - any environmental factor or
3. Protected poor health in a stressor (biologic, chemical,
favorable environment mechanical, physical, or
4. Poor health in unfavorable psychosocial) that by its presence
environment or absence (e.g., lack of essential
nutrients) can lead to illness or
disease.
2. Host - Person(s) who may or may
not be at risk of acquiring a
disease. Family history, age, and
lifestyle habits influence the host’s
reaction.
3. Environment - All factors external
to the host that may or may not
predispose the person to the
High level wellness- encourages the development of disease. Physical
nurse to care for the total person environment includes climate,
-involves functioning to one’s maximum living conditions, sound (noise)
potential while maintaining balance and a levels, and economic level. Social
purposeful direction environment includes interactions
-regards wellness as an active state, with others and life events, such as
oriented towards maximizing the potential the death of a spouse.
of the individual
Health is maintained when
2. Agent-Host-Environment model by variables are in balance
leavell and clark
3. Iceberg model
-reveal only a small part of their
true size above water
-90% sumberged

-aka ecologic model

-general theory 4. Travis’ illness wellness continuum
 Intellectual - recognizing creative abilities
and finding ways to expand knowledge
and skills

PERCEPTIONS TO HEALTH
-well being includes mental and emotional
health as well as the absence or Clinical Model
presence of illness (travis, 1972) The narrowest interpretation of
-movement to the right of the neutral point health occurs in the clinical model. People
indicates wellness are viewed as physiological systems with
related functions, and health is identified
5. Illness-wellness continua (Anspaugh, by the absence of signs and symptoms of
Hamrick, Rosato) disease or injury. It is considered the
state of not being “sick.” In this model, the
opposite of health is disease or injury.
Many medical practitioners have used the
clinical model in their focus on the relief of
signs and symptoms of disease and
elimination of malfunction and pain. When
these signs and symptoms are no longer
present, the medical practitioner
considers the individual’s health restored.
6. Hollistic Health model
-mind, body, and soul = congruence Role Performance Model
-person as a holistic being Health is defined in terms of an
individual’s ability to fulfill societal roles,
Is Illness and disease similar? that is, to perform his or her work. People
Emotional - coping effectively w/ life and usually fulfill several roles (e.g., mother,
creating satisfying relationships daughter, friend), and certain individuals
Physical - recognizing the need for may consider nonwork roles the most
physical activity, diet, sleep and nutrition important ones in their lives. According
Socio-cultural - developing a sense of to this model, people who can fulfill their
connection, belonging and a well- roles are healthy even if they have clinical
developed support system illness. For example, a man who works all
Financial - satisfaction with current and day at his job as expected is healthy even
future financial situations though he is partially deaf. It is assumed
Environmental - good health by occupying in this model that sickness is the inability
pleasant, stimulating environments that to perform one’s work role.
support well-being
Occupational - personal satisfaction and Adaptive Model
enrichment derived from one’s work In the adaptive model, health is a
Spiritual - expanding our sense of creative process; disease is a failure in
purpose and meaning in life
adaptation, or maladaptation. The aim of capacity of the whole and is revealed in
treatment is to restore the evolving pattern. Pattern identifies the
the ability of the person to adapt, that is, human–environmental process and is
to cope. According to this model, extreme characterized by meaning. (p. 6)
good health is flexible adaptation to the
environment and interaction with the Disease
environment to maximum advantage. The -failure of adaptive mechanisms
famous Roy adaptation model of nursing -identified by clinical manifestations
(Roy, 2009) views the person as an explained by organic cause
adaptive system (see Chapter 3 ). The -can be present without feeling of illness
focus of this model is stability, although - medical term that can be described as
there is also an element of growth and an alteration in the body functions
change. -can be describes as acute or chronic,
communicable, congenital, degenerative,
Eudaimonistic model functional, malignant, psychosomatic, or
incorporates a comprehensive idiopathic
view of health. Health is seen as a -failure of a person’s adaptive
condition of actualization or realization of mechanisms to adequately counteract
a person’s potential. Actualization is the stimuli and stresses resuliting in
apex of the fully developed personality, functional or structural disturbances
described by Abraham Maslow (see
Chapter 16 ). In this model the highest The causation of disease is called
aspiration of people is fulfillment and etiology
complete development, which is
actualization. Illness, in this model, is a *Disease has etiology*
condition that prevents self-actualization. Disease - can be used in two main
Pender, Murdaugh, and Parsons (2011) definitions
include stabilizing and actualizing 1. Any pathological (unhealthy)
tendencies in their definition of health: condition, bodily or mental whether
“the realization of human potential caused through accident or injury
through goal-directed behavior, 2. It can be used to refer to a specific
competent selfcare, and satisfying medically diagnores condition with
relationships with others while adapting to distinctive, recognized symptoms -
maintain structural integrity and harmony subjective or objective?
with the social and physical
environments” (p. 22). Another model of Illness
this type is that of Margaret Newman *feeling*
(2008) who states that health is the -a disabling response
expansion of consciousness. The basic -broader, including client’s perceptions
assumptions of this model or theory are: and responses
Health is an evolving unitary pattern of - a highly personal state in which the
the whole, including patterns of disease. person feels unhealthy or ill
Consciousness is the informational -diminished functional capacity
-may or may not be related to a disease 1. Clients are not held responsible for
-a state of disturbance in the normal their condition. Even if the
functioning of the total human individual illness was partially caused by an
including both the state of the organism individual’s behavior (e.g., lung
as a biological system and social cancer from smoking), the individual is
adjustment not capable of reversing
the condition on his or her own.
3 criteria for illness 2. Clients are excused from certain social
1. Presence of symptoms roles and tasks. For example, an ill parent
2. Perception of how they feel would not be expected to prepare meals
3. Ability to function for
the family.
Sickness - social state or social role 3. Clients are obliged to try to get well as
Illness - sunjective experience quickly as possible. The
ill person should follow legitimate advice
Types of illness regarding a specialized
Acute - relatively short duration diet or activity restrictions that could help
Chronic - usually 6 months or longer with recovery.
4. Clients or their families are obliged to
Remission - symptoms disappear seek competent help. For
Exacerbation - symptoms reappear example, the ill person should contact the
primary care provider rather than relying
Illness behavior solely on his or her own ideas of how
-coping mechanism involves ways to recover.
individuals describe, monitor, and
interpret their Stages of illness
symptoms, take remedial actions, and STAGE 1: SYMPTOM EXPERIENCES
use the health care system At this stage the person comes to believe
-How people behave when they are ill is something is wrong. Either
highly individualized and affected by someone significant mentions that the
many variables: person looks unwell, or the
● Age person experiences some symptoms
● Sex such as pain, rash, cough, fever,
● Occupation or bleeding. Stage 1 has three aspects:
● Socioeconomic status • The physical experience of symptoms
● Religion • The cognitive aspect (the interpretation
● Ethnic origin of the symptoms in terms
● Psychologic stability that have some meaning to the person)
● Personality • The emotional response (e.g., fear or
● Education anxiety)
● Modes of coping During this stage, the unwell person
usually consults others about the
4 aspects of a sick role symptoms or feelings, validating with
support people that the symptoms are STAGE 5: RECOVERY OR
real. At this stage, the sick person may try REHABILITATION
home remedies. If self-management is During this stage, the client is expected to
ineffective, the individual enters the next relinquish the dependent
stage. role and resume former roles and
responsibilities. For people with
STAGE 2: ASSUMPTION OF THE SICK acute illness, the time as an ill person is
ROLE generally short and recovery is usually
The individual now accepts the sick role rapid. Thus most find it relatively easy to
and seeks confirmation from return to their
family and friends. Often people continue former lifestyles. People who have long-
with self-treatment and term illnesses and must adjust their
delay contact with health care lifestyles may find recovery more difficult.
professionals as long as possible. During For clients with
this stage people may be excused from a permanent disability, this final stage
normal duties and role expectations may require therapy to learn
how to make major adjustments in
STAGE 3: MEDICAL CARE CONTACT functioning
Sick people seek the advice of a health
professional either on their own Adapting to Illness
initiative or at the urging of significant Effects of Illness
others. When people seek professional Illness brings about changes in both the
advice, they are really asking for three involved individual and in
types of information: the family. The changes vary depending
• Validation of real illness on the nature, severity, and
• Explanation of the symptoms in duration of the illness, attitudes
understandable terms associated with the illness by the client
• Reassurance that they will be all right or and others, the financial demands, the
prediction of what the lifestyle changes incurred, adjustments to
outcome will be. usual roles, and so on.
I. Impact on the client
STAGE 4: DEPENDENT CLIENT ROLE A. Behavioral and Emotional Changes -
After accepting the illness and seeking may become irritable and lack the energy
treatment, the client becomes dependent or desire to interact in the usual fashion
on the professional for help. People vary with
greatly in the degree of ease with which family members or friends.
they can give up their independence, B. Changes in Body Image
particularly in relation to life and death. Body image - subective concept of
Role obligations—such as those of wage physical appearance
earner, parent, student, sports team *some illnesses result in physical
member, or choir member—complicate appearance changes
the decision to give up independence. - Type of change
- Adaptive capacity
 - Rate at which the change took It involves but is not limited to changes in
- Support services available diet and exercise
Process/phases of adjustment:
1. Shock - depersonalize How can Nurses help?
2. Withdrawal - upon recognition of -make changes to accommodate the
reality; may become anxious or client’s lifestyle
withdraw -encourage other health professionals to
3. Acknowledgment - upon become aware of the client’s lifestyle
acknowledgment of the change - a practices
movement to the grieving process -reinforce desirable changes in practices
4. Acceptance - at the end of with a view to making them a permanent
acknowledgment phase - part of the client’s lifestyle
acceptance of loss
5. Rehabilitation - readiness to learn Impact on Family
how to adapt to change in body A person’s illness affects not only the
image through the use of person who is ill but also the
prosthesis or change in lifestyle family or significant others. The kind of
C. Impact on self-concept effect and its extent depend
Self concept - the mental self-image of chiefly on three factors:
strengths and weaknesses (1) the member of the family who is ill,
Self-esteem - overall feeling of self-worth (2) the seriousness and length of the
or the emotional appraisal of self-concept illness,
Common stressors that influence self- (3) the cultural and social customs the
concept: family follows
- Body image
- Identity The changes that can occur in the
- Role performance family include the following:
• Role changes
D. Loss of autonomy • Task reassignments and increased
-state of being independent and self- demands on time
directed without control • Increased stress due to anxiety about
-family interactions may change- the the outcome of the illness for
client may no longer be involved in the client and conflict about
making family decisions unaccustomed responsibilities
-nurses need to support clients’ right to • Financial problems
self-determination and autonomy • Loneliness as a result of separation and
*provide information and let them pending loss
participate in decision making • Change in social customs.

E. Changes in Lifestyle
-often necessary in relation to treatments Determinants for seeking medical
and taking of prescribed medications care:
-visibility and recognition of symptoms
-severity of symptoms -the shift in emphasis from cure to care
-the extent to which symptoms disrupt -public dissatisfaction with depersonalized
family care
-frequency and persistence -recognition of limits to modern medicine
-amount of tolerance for the symptoms -increased visibility of alternative healing
-the consciousness of the effects of
Levels of preventive care lifestyle
● Primary - diet, exercise, -the desire to exercise personal
immunization responsibility
● Secondary - screenings, -access to information on the internet
mammograms, family counseling
● Tertiary - medical, surgical, Sociodynamic variables in help-
rehabilitation seeking behavior:
-age
Health and Illness Behavior -sex
Health behavior - purpose of maintaining -ethnicity
or enhancing health -socioeconomic status
Illness behavior - purpose of defining
illness or seeking relief from it Health status
-state of an individual at a given time
Health lifestyles
-health related behaviors based on Health beliefs
choices from options available -concepts of health that an individual
-determined by a person’s position in the believes is true
society -may be confounded on fact
-either positive or negative for the -a person’s ideas, convictions, and beliefs
person’s body and mind about health and illness
-Not based on what one produces, but
consumes Health Behaviors
-attempt to produce good health Actions people take to:
-understand their health state
Seeking Health care -maintain an optimal state of health
-responding to symptoms -present illness and injury
-when discomfort is severe Precursor of illness - trigger
Vulnerability - susceptibility to diseases or
Self-care illnesses
-most common response to symptoms Risk factors - aspect of personal behavior
-include taking preventive measures or lifestyle. Environmental exposure or
-managing chronic conditions inborn or inherited characteristics
-may involve consultations
-includes both health and illness behavior Risk factors
1. Heredity
Factors promoting interest in self-care: 2. Behavioral factors
 3. Environmental factors ● Basic human needs
● self concept
non -modifiable risk factors:
- Age Factors that affect self-concept
- Sex ● Past
- Race ● Interpersonal relationships
- Genetics
Modifiable risk factors The poor are disadvantaged
- Stress
- Nicotine
- Diet
- Exercise
- Alcohol
- Drugs
- Environment
- Immunization

Self-management support strategies

-based on 3 categories of skills needed
by clients
● Medical or behavioral management Communication
● Role management
● Affective or emotional Aspects of communication:
management Sender - the one who conveys the
-Problem solving message to another person
● Problem identification and Message - the thought, idea, or emotion
definition conveyed
● Solution options Channel - how the message is sent
● Implementation of solutions Receiver - physiological/psychological
● Evaluation components
-decision making - the outcome of their Feedback - the receiver’s response to the
decision to adopt a healthy lifestyle will sender
have an effect on their health Influences - culture, education, emotions,
-resource utilization - includes social and other factors involved
support, access to fitness facilities, and
internet Methods of communication
Verbal - speaking, writing, listening,
Factors affecting health status, beliefs, reading
and practices Non-verbal - gestures, facial expressions,
● Risk factors for illness posture and gait, tone of voice, touch, eye
● Factors in human dimensions that contact, body position, physical
influence health illness status appearance
● Beliefs and practices
Inluences of communication Communication techniques
● Age - clarifying/validating
● Education - Asking open questions
● Emotions - Using indirect statements
● Culture - Reflecting
● Language - Paraphrasing
● Attention - Summarizing
● Surroundings - Focusing
- Silence
Congruency of messages *why questions are judgmental*
- Verbal and non-verbal
communication must be congruent, Barriers in Communication
or in agreement - Closed questions
Listening and Observing - False reassurance
- Two of the most valuable - Judgmental responses
- Used to gather subjective and - Defensive reflex
objective data - agreeing/disagreeing or
Active listening approving/disapproving
- Process of hearing spoken words - Giving advice
and noting non verbal behavior - Requesting an explanation
- Takes energy and concentration - Changing the subject
Therapeutic Communication
To Establish Rapport
Therapeutic communication ● Offering Self: I’ll sit with you a
- Sometimes called effective while
communication; purposeful and ● Giving Information: your husband
goal oriented can stay here during visiting hours
● Use of silence: providing time for
Goals the patient to pigeonhole thoughts
- To obtain or provide information and feelings
- To develop trust To Congregate Information
- To show caring ● Clarifying: I’m not sure what you
- To explore feelings mean, could you explain it to me
again?
Enhancing communication ● Validating: are you saying that…?
- Self-disclosure ● Restating: ‘I can’t sleep, there are
- Caring lots of thoughts in my mind’ you
- Genuineness have difficulty sleeping?
- Warmth ● Reflecting: My heart beats fast and
- Active listening my vision becomes blurred when
- Empathy she passes by’ you feel tense
- Acceptance and respect when you see her
 ● Focusing: ‘I know that my mother saying without taking away the initiative
hates me’ what makes you think for interaction
that way or tell me more how you Placing the event in time or sequence -
feel clarifying the events of relationship in time
To Close Conversation “What seemed to lead up to…” “was this
● Summarizing - Developing a terse before or after…?” “when did this
thought of a conversation happen?”
Putting events in proper sequence helps
Therapeutic Communication both the nurse and client to see them in
Techniques perspective
Accepting- giving an indication of Making observations - verbalizing what is
reception perceived
“Yes” “I follow what you said”; nodding “You appear tense” “are you
Indicates that the nurse has heard and uncomfortable when you…” “I notice that
has followed the trend of thought. It does you’re biting your lip…”
not indicate agreement but is non- The nurse often makes an observation
judgmental in nature that can be called to the clients' attention.
Giving Recognition - acknowledging, The nurse and client can discuss how the
indicating awareness client is feeling
“Good morning Mr. s” “you’ve finished Encouraging description of perception -
your list of things to do” “I notice that asking the client to verbalize what he or
you’ve combed your hair” she perceives
Greeting the client by name, indicating “Tell me when you feel anxious” “What is
awareness of the change, noting efforts happening?” “what does the voice seem
the client has made- all these show that to be saying?”
the nurse recognizes the client as a If the nurse is to understand the client, he
person or she must come to see things from the
Offering self - making one’s self available client’s perspective
“I’ll sit with you a while” “I’ll stay here with Encouraging comparison - asking that
you” “I’m interested in what you’re similarities and differences be noted
thinking” “Was this something like...:” “Have you
The nurse can offer his or her presence, had similar experiences?”
interest, and desire to understand Comparing ideas or experiences or
Giving broad openings - allowing the relationships brings out many recurrent
client to take the lead in introducing a themes. The client benefit from making
topic these comparisons
“Is there anything you want to talk about?” Restating - repeating the main idea
“what are you talking about?” expressed
Offering General Leads - giving C: I can’t sleep, I stay awake all night
encouragement to continue N: you have difficulty sleeping
“Go on” “and then?” “tell me about it” C I am so upset
General leads indicate the nurse is N: you’re really mad and upset
listening and following what the client is
This lets the client know that the idea was nurse avoid making assumptions that
communicated effectively understanding has occurred when it has
Reflecting - directing questions, feelings, not
or ideas back to clients Presenting reality - offering for
C: do you think I should tell the doctor? consideration that which is not real
N: do you think you should tell the doctor? “I see no one else in the room” “that
Reflection encourages the client to sound was a car backfiring” “your mother
recognize and accept his or her own is not here; I’m a nurse”
feelings When it is obvious that the client is
Focusing - concentrating on a single point misinterpreting reality, the nurse can
“This point seems worth looking at more indicate that which is real
closely” “of all the concerns you’ve Voicing Doubt - expressing uncertainty
mentioned, which one is the most about the reality of the client’s
troublesome?” perceptions
The client can be encouraged to “Isn’t that unusual?” “really?” “that’s hard
concentrate his or her energies on a to believe”
single point and may avoid being Another means of responding to
overwhelmed by a multitude of factors or distortions of reality is to express doubt.
problems Such expression permits the client to
Exploring - delving further into a subject become aware that others do not
or idea necessarily perceive events in the same
“Tell me more about that” “would you like way or draw the same conclusions as the
to describe it more fully?” “what kind of client does
work?” Verbalizing the Implied - voicing at what
Exploring can help clients examine topics the client has hinted at or suggested
more fully. Any problem or concern can C: I can’t talk to you or anyone. It’s a
be better understood if explored in depth waste of time
Giving information - making available the N: is it your feeling that no one
facts the client needs understands?
“My name is…” “visiting hours are…” “my C: my wife pushes me around just like my
purpose in being here is…” “I’m taking mother and sister did
you to…” N: is it your impression that women are
Informing the client of facts increases his domineering
or her knowledge about a topic or lets the Putting into words what has been implied
client know what to expect or said indirectly tends to make the
Seeking Information - seeking to make discussion less obscure
clear that which is not meaningful or that Encouraging Expression - asking the
which is vague client to appraise the quality of his or her
“I’m not sure that I follow” “what would experiences
you say is the main point of what you just “What are your feelings in regards to…”
said?” “have I heard you correctly?” “does this contribute to your discomfort?”
Clarification should be sought throughout The client is asked to consider people
interactions with clients. This can help the and events in light of his or her own
values. The client is encouraged to make Advising
his or her own appraisal rather than Belittling
accepting the opinions of others Approving
Attempting to translate into feelings -
seeking to verbalize feelings that are only Reassuring - indicating that there is no
expressed indirectly cause for anxiety
C: I’m dead “I wouldn’t worry about that” “everything
N: are you suggesting that you feel will be alright” “you’re coming along just
lifeless? Or is it that life seems to have no fine”
meaning To attempt to dispel the client’s anxiety by
Often what the client says, when taken implying that there is no sufficient reason
literally, seems meaningless or far for concern is to completely devalue the
removed from reality. To understand, the client’s feelings
nurse must concentrate on what the client Giving Approval - sanctioning the client’s
might be feeling in order to express him behavior or ideas
or herself in this manner “That’s good” “I’m glad that you…”
Suggesting Collaboration - offering to Saying what the client thinks or feels is
share, to strive to work together with the “good”, implies that the opposite is “bad”.
client for his or her benefit Approval tends to limit the client’s
“Perhaps you and I can discuss and freedom to think, speak, or act a certain
discover what produces your anxiety” way
“let’s go to your room, and I’ll help you Rejecting - refusing to consider or
find what you’re looking for showing contempt for the client’s ideas or
The nurse seeks to offer the client a behavior
relationship in which the client can identify “Let’s not discuss…” “I don’t want to hear
problems in living with others, grow about…:
emotionally, and improve the ability to When any topic is rejected, it is closed off
form satisfactory relationships from exploration
Summarizing - organizing and summing Disapproving - denouncing the client’s
up that which has gone before behavior or ideas
“Have I got this straight?” “you’ve said “That’s bad” “I’d rather you wouldn’t”
that…” “during the past hour, you and I Disapproval implies that the nurse has the
have discussed…” right to pass judgment in the client’s
Summarizing seeks to bring out the thoughts and actions. It further implies
important points of the discussion and to that the client is expected to please the
increase awareness and understanding of nurse
both participants. Agreeing - indicating accord with the
Non-therapeutic Communication client
Disapproving “That’s right” “I agree”
Interrupting While approval indicated that the client is
Social response “good” rather than “bad”, agreeing
Moralizing indicates that the client is “right” rather
Topic changing than “wrong”
Disagreeing - opposing the client’s ideas Defending what the client has criticized
“That’s wrong” “I definitely disagree with” implies that the client has no right to
“I don’t believe that” express his or her impressions, opinions,
Disagreeing implies that the client is or feelings.
“wrong”. Consequently, the client feels as Requesting an Explanation - asking the
if he or she has to defend their point of client to provide reasons for thoughts,
view or ideas feelings, behaviors, and events
Advising - telling the client what to do “Why do you think that?” “why do you feel
“I think you should…” “why don’t you…” this way?” “why did you do that?”
Giving advise implies that only the nurse There is a difference between asking the
knows what is best for the client, instead client to describe what is occurring or has
of the client himself or herself taken and asking him to explain why.
Probing - persistent questioning of the Indicating the Existence of an External
client Source - attributing the source of
“Now tell me about it” “tell me your life thoughts, feelings, and behavior to others
history” or to outside influences
Probing tends to make the client feel used “What makes you say that?” “who told
or invaded. Clients have the right not to you that you were Jesus?” “what made
talk about issues or concerns if they you do that?”
choose. It seems to imply that the client was made
Challenging - demanding proof from the or compelled to think in a certain way.
client usually, the nurse does not intend to
“But how can you be the president of the suggest that the source is external, but
united states?” that is often the client’s interpretation.
“If you’re dead, why is your heart Belittling Feelings Expressed - misjudging
beating?” the degree of the client’s discomfort
Challenging causes the client to become C: I have nothing to live for, I wish I was
defensive, and the client defends the dead
delusions or misperceptions more N: everybody gets down in the dumps
strongly than before The nurse implies that the do=iscomfor is
Testing - appraising the client’s degree of temporary, mild, self-limiting, or not
insight important
“Do you still have the idea that….” “do Making Stereotyped Comments - offering
you know what kind of hospital this is?” meaningless cliches or trite expressions
These types of questions are forcing the “Nice weather we’re having” “I'm fine and
client to try to recognize their problems how are you?”
Defending - attempting to protect Such comments are of no value in the
someone or something from verbal attack nurse-client relationship
“This hospital has a fine reputation” “no Giving Literal Responses - responding to
one here would lie to you” “I’m sure that a figurative comment as though it w3re a
your doctor has your best interest in statement of fact
mind” C: I’m an easter egg
N: what color?
Often the client is at a loss to describe his Passive - apologetic, weak, makes little
or her feelings, so comments like these eye contact, often fidgety
are the best the client can muster. Aggressive - haughty, angry, demanding,
Usually, it is helpful for the nurse to focus shows no concern for anyone else’s
on the client’s feelings in response to feelings
statements such as these Assertive - honest, direct, firm, makes
Using Denial - refusing to admit that a eye contact, confident, respectful to
problem exists others
C: I’m nothing
N: of course you’re something. Gestures - movements of the hands and
Everybody’s something arms
The nurse is denying the client’s feelings - Nurses must be sensitive to
or the seriousness of the situation by cultural variances with regard to
dismissing the comments without gestures
attempting to discover the feelings or Meaning of Time - in the US, great
meaning behind such statements emphasis is placed on time and
Interpreting - seeking to make conscious schedules. Being in time is very important
that which is unconscious, telling the - In other cultures, such emphasis is
client the meaning of his or her not placed on time
experience Meaning of Space - human beings all
“What you really mean is…” observe rules around comfort zones - the
“unconsciously you’re saying…” distance between 2 people
The cleitn’s thoughts and feelings are his - Intimate: touch to 18 in
or her own, not to be interpreted by the - Personal: 18 in 4 ft
nurse or interpreted for hidden meaning - Social: 4ft to 12 ft
Introducing an Unrelated Topic - changing - Public: 12ft or more
the subject Cultural Values - a nurse should be
C: I’d like to die familiar with the cultural values of the
N: Did you have visitors this weekend? people in the nurse’s region of
The nurse takes initiative for the employment
interaction away from the client - A nurse needs to be aware of
those times when her values differ
Psychosocial Aspects of from the values of the dominant
Communication culture
● Style Political Correctness - to be politically
● Gestures correct in communication means to use
● Meaning of time language sensitive to those who are
● Meaning of space different from oneself
● Cultural values
● Political correctness Nurse-Client Communication
- Almost every nurse-client
3 types of style interaction should involve
therapeutic communication
 - Influenced by both the nurse and Oral communication - nurses
the client communicate with many different
Three phases of Nurse-Client relationships, each with their own rules
Communication ● Nurse-nurse
Introduction - fairly short; expectations ● Nurse-nursing assistant
clarified; mutual goals set ● Nurse-student nurse
Working - a major portion of the ● Nurse-physician
interaction; used to accomplish goals ● Nurse-other health professionals
outlined in introduction; feedback from ● Group communication
client essential Written Communication - nurse’s
Termination - nurse asks if client has communications are often written:
questions; summarizing the topic is ● On charts
another way to indicate closure ● Requisitions for x-rays and other
Determinant Factors in tests and services
Communication ● Electronic communications via
A nurse’s communication is affected by: computer
● Past experience ● Telemedicine: the use of
● State of health communications tech to transmit
● Home situation health information from one
● Workload location to another
● Staff relations Self-reflection - nurses often engage in
● self -awareness internal dialogue:
A client’s communication is affected by: ● Positive self talk: saying positive
● Social factors thoughts aloud; thinking, saying
● Religion and hearing positive statements
● Family situation about yourself
● Level of consciousness ● Negative self-talk: self-destructive.
● Stage of illness Your self-image is lowered by your
● Visual, hearing, and speech ability own criticism
● Language proficiency
Therapeutic relationship
Communication with the healthcare team - The primary mode of implementing
-providing care is a team effort interventions in psychiatric nursing
-to ensure efficiency and effectiveness, - Phases:
effective communication is necessary - Orientation
-this communication may be oral or - Working
written - Termination

The nurse’s ways of communication

● Oral
● Written
● Self-reflection
 - Students may have Boundaries - general principles of
boundaries in professional relationships
- Special issues in mental health
- Client’s perception of the
nurse’s actions
- A setting for the interaction
- Use of touch

Essential Components of Therapeutic

Communication
Privacy and respect for boundaries -
interaction phase therapeutic communication is most
comfortable at 3-6 ft; should not be less
than 18 inches
Touching - touch may be comforting and
supportive. Touch is also an invasion of
intimate and personal space. A nurse
must evaluate whether the clients
perceive touch as positive or threatening
and unwanted; never assume that
touching a client is acceptable

Nursing
- Is an art and a science
Effective Nurse behavior
- Earlier emphasis focused on care
- Active listening
of the sick patient; the promotion of
- Focus on client
health is stressed
- Self-awareness
- Diagnosis and treatment of the
- Professional caring
human response to actual potential
- Genuine
health problems (ANA, 1980)
- Interest
- The act of utilizing the environment
- Acceptance
of the patient to assist him in his
Ineffective Nurse Behavior
recovery (nightingale, 1860)
- Excessive self-disclosure
- The unique function of The nurse
- Anxiety
is to assist individuals, sick or well,
- Distracting nonverbal mannerisms
on the performance of those
of behavior
activities contributing to health or
- Excessive talking
its recovery (or to peaceful death)
- Asking multiple questions
That she would perform a needed
- Rushing the interaction process
if you have the necessary strength
will our knowledge and to do This
 in such a way as to help them gain - occupation that requires extensive
independence as rapidly as education or a calling that requires
possible (virginia henderson, 1966) special knowledge, skills, and
- Nursing practice is a dynamic, preparation
caring, helping relationship in - is generally distinguished from
which the nurse assists a client to other kinds of occupation by:
achieve and obtain optimal health a. It's requirement of
prolonged specialized
The following themes are common in the training to acquire body of
definition of nursing knowledge Pertinent to the
- Nursing as caring * Nursing is an role to be performed
art Nursing is a science b. the orientation of the
- Nursing is client-centered individual towards service,
- Nursing is holistic either to a community or to
- Nursing is adaptive an organization
- Nursing is concerned with health c. ongoing research
promotion, health maintenance, d. Code of ethics
and health restoration e. Autonomy
- Nursing is a helping profession f. professional organization

Personal professional qualities of a nurse Professional nurse - A professional nurse

1. interest and willingness to work is a person has completed a basic
and live with individuals or groups nursing education program and is
in a variety of settings licensed in his or her country or state to
2. a warm personality and concern practice professional nursing
for people
3. resourcefulness and creativity as Criteria of a profession
well as a well balanced emotional * specialized education - an important
condition aspect of the professional status
4. Capacity and ability to work - the ana recommends
operatively with others baccalaureate degree as the entry
5. initiative to improve self and level for professional practice
service - In the usa there are five means of
6. competence in performing work entry: Hospital diploma , associate
through the use of the nursing degree , baccalaureate , masters,
process doctoral
7. skills in Decision making, *Body of knowledge - Establishing a well-
communicating, and relating with defined body of knowledge and expertise
others and being research oriented - number of nursing conceptual
8. active participation and issues frameworks contribute to the
confronting nurses and nursing knowledge base of nursing and
give direction to the nursing
Profession
 practice, education and ongoing maxims to connect an understanding on
research the appropriate action
*Service orientation - Hallmark of a
profession is altruism Classifications of nurses
*ongoing research - Increasing research A. according to the field of nursing
is contributing to the nursing practice a. institutional nurses
- since the 1970 , the nursing b. public health
research has focused on practice- i. Chn nurses
related issues or the evidence- ii. School
based research iii. Occupational
*Code of Ethics - The nursing profession iv. Mcn
requires integrity of its members v. Tuberculosis
- nursing has developed own code vi. Nurse educator
of ethics and the setup means to B. According to to types of duty
monitor the professional behavior a. General duty nurse
of its members b. Private duty nurse
*Autonomy - A profession is autonomous C. According to types of position
if it regulates itself and sets standards a. Adminisrator or [Link]
b. Consultant
Levels of proficiency according to benner c. Clinical specialist
stage 1 novice - No experience. d. Supervisor or asst.
impossible and governed by context-free e. Instructor
rules and regulations rather than f. Head nurse or charge nurse
experience g. General duty nurse or staff
stage 2 advanced beginner - nurse
demonstrates marginally acceptable D. According to professional status
Performance. has experienced enough a. Active
real situation to make judgments about b. Inactive
them. Nursing ethics - a system of principles
stage 3 competence - has two or three governing the conduct of nurses, it deals
years of experience. demonstrate with the relationship of a nurse to the
organizational and Planning abilities. patient , patient's family , her associate
Differentiate important to non important fellow nurses and society at large
factors of care Code of nursing ethics in the philippines
Stage 4 proficient - 3 to 5 years of adopted and promulgated on march 2
experience. Receive situations as wholes 1984 based on the code of nurses
rather than parts. Use maxims as giudes. adopted by the council of national
Holistic understanding patient, focus on representatives of the international
long-term goals council of nurses in mexico city in may
Stage 5 expert - performance is fluid, 1973
flexible, highly proficient. Highly skilled.
No longer requires rules, guidelines, Ethical concepts of the pna code of ethics
 1. Health is a basic right of every
individual
2. basic to nursing is the
understanding of man
3. basic to nursing is the respect for
the life , dignity and rights of man
4. nursing must respond to change
5. standards of practice vary

Areas of responsibility
1. People and society
a. Nurses and people
b. Nurses and society
2. Practice and profession
a. nurses and practice
b. Nurses and profession
3. Colleagues and co-workers
4. Ourselves as nurse